3d printed osteogenesis scaffold

ABSTRACT

Osteogenesis scaffold such as for spinal fusion or an intermedullary nail includes a number of arcuate struts. The scaffold may have a functional modulus of elasticity that is a result of the modulus of the material of the struts together with the architecture of the struts, and may be within the range of 5 GPa and 75 GPa. An anisotropy of a physical property such as stiffness, compressive strength or elastic modulus corresponds to the same physical property of native bone in the vicinity of the intended implantation site.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. application Ser.No. 16/711,091, filed Dec. 11, 2019, which is a continuation applicationof U.S. application Ser. No. 15/947620, filed Apr. 6, 2018, which is acontinuation application of U.S. application Ser. No. 15/299,347, filedOct. 20, 2016, which claims the priority benefit under 35 U.S.C. §119(e) of U.S. Provisional Application No. 62/244,374, filed Oct. 21,2015, the entireties of which are hereby incorporated by referenceherein.

BACKGROUND OF THE INVENTION

Spondylosyndesis, or spinal fusion, is a surgical technique used tocombine two or more vertebrae into a single, rigid working unit. This istypically achieved by introducing a supplementary bone tissue, such asan autograft or allograft, into the intervertebral space between twotarget vertebrae, at the location that is typically occupied by anintervertebral disc. The supplementary bone tissue is then used inconjunction with the patient's natural osteoblastic processes in orderto grow bone or osseous tissue between the two or more target vertebrae,which acts to fuse them together into the desired rigid unit. Thisprocedure is used primarily to eliminate pain that is caused by abnormalmotion of one or both of the target vertebrae; pain relief occurs byimmobilizing the vertebrae themselves and preventing the abnormalmotion. Alternatively, surgically implantable synthetic intervertebralfusion cages or devices may be used to perform spinal fusion procedures.

Surgically implantable intervertebral fusion cages are well known in theart and have been actively used to perform spinal fusion procedures formany years. Their use became popularized during the mid 1990's with theintroduction of the BAK Device from the Zimmer Inc. The BAK system is afenestrated, threaded, cylindrical, titanium alloy device that iscapable of being implanted into a patient as described above through ananterior or posterior approach, and is indicated for cervical and lumbarspinal surgery. Most common spinal fusion systems today are made frommetals, such as titanium or cobalt chrome alloys, or from a polymer suchas polyetheretherketone (PEEK) which is commonly used in biomedicalimplants. Unfortunately, these implant materials have a modulus which ismuch higher than that of bone and there is clinical evidence of implantsubsidence and movement which is believed to be attributable tomechanical incompatibility between natural bone and the implantmaterial. Also bone pressure necrosis does occur as a result of thepresence of these metal implants.

Implants based on bone material from a donor (allograft) or from thepatient itself (autograft) do have an inconsistent mechanical strengthand show subsidence over time. The inconsistent properties of theseimplants make them generally unpredictable, challenging to reliablymachine and especially prone to migration and explusion due to thedifficulty of consistently machining teeth into the upper and lowerimplant contact surfaces.

Although titanium alloy cages give good fusion rates, their modulus issignificantly dissimilar to human bone. The stress transfer between animplant device and a bone is not homogeneous when Young's moduli of theimplant device and the bone are different. This results in stressshielding. In such conditions, bone atrophy occurs and leads to theloosening of at the implant bone interface and eventually lead tofailure. Therefore, the stiffness (Young's modulus) of the implant ispreferably not too high compared to that of bone. Implant devices madefrom metallic biomaterials such as stainless steels, Co—Cr alloys, andtitanium (Ti) and its alloys have a Young's modus generally much greaterthan that of the bone. Young's moduli of the most widely used stainlesssteel for implant devices, SUS316L stainless steel and Co—Cr alloys, arearound 180 GPa and 210 GPa, respectively. Young's moduli of Ti (puretitanium) and its alloys are generally smaller than those of stainlesssteels and Co—Cr alloys. For example, Ti and its alloy, Ti-6Al-4V ELI,which are widely used for constructing implant devices, have a Young'smodulus of around 110 GPa. However, this value is still higher than thatof the bone, which is on the order of 10-30 GPa.

The foregoing shortcomings in the spinal fusion cage arts apply to otherorthopedic implants as well, such as intermedullary nails for long bonessuch as the femur.

Therefore, there remains a need for a biostable implant such as for useas an orthopedic implant or plate which has a tensile modulus comparableto that of bone, which does not subside and provides a good stability.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side elevational perspective view of an implant inaccordance with the present invention, in the form of a spinal fusioncage.

FIG. 2 is a top plan view of the spinal fusion cage shown in FIG. 1.

FIG. 3 is a perspective elevational cross section through the spinalcage of FIG. 2.

FIG. 4 is an elevational cross section through the cage of FIG. 2, takenalong an axis perpendicular to the cross-section of FIG. 3.

FIG. 5 is a side elevational view of the cage of FIG. 1.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The present invention addresses the problem by providing implants suchas intermedullary nails or spinal fusion cages that have a functionalmodulus of elasticity that is substantially the same as the modulus ofelasticity of the native bone at the implant site. For example, implantscan be provided having a functional modulus of elasticity of betweenabout 5 GPa and about 75 GPa, typically between about 10 GPa and about50 GPa and in some implementations between about 10 and about 30 GPa.Functional modulus means the effective modulus of the final implant,which will be the result of both the modulus of the material of theimplant as well as the result of the arcuate strut architecture of theimplant, as will be described below.

In addition, human or animal tissue is generally not structurallyisotropic. For example, cancellous bone includes trabeculae, alsoreferred to as spicules, defining a plurality of open spaces. Thetrabeculae and open spaces are generally oriented in a direction ofprinciple stress (e.g., axially along a long bone such as a femur). Thetrabeculae form a porous or spongy-type tissue that is generally stifferin a particular direction. For example, cancellous bone in the femur isgenerally stiffer axially than radially to accommodate an axialdirection of the primary stress on the bone.

A prosthetic orthopedic implant such as a fusion cage should thereforebe designed to avoid producing load concentrations which can lead tostress shielding of nearby bone. Bone can remodel to adapt to the loadapplied to it. If a particular location within a bone experiencesincreased load, the body will increase bone growth at that location. Thereverse is also true. In response to a reduced load at a particularlocation, the body will tend to resorb bone from that location.Therefore, concentrating stresses within a prosthetic implant providingstructural support can lead to weakening and resorption of thesurrounding bone.

An isotropic implant together with the anisotropy of nearby bone, canlead to stress shielding, such as if the isotropic implant is stiffer inone direction (e.g., in a radial direction, for a long bone such as afemur) than the nearby native bone. An anisotropic porous scaffoldsupport structure can help reduce or avoid such stress shielding, suchas by providing anisotropy in a similar direction to the anisotropy ofthe nearby native bone.

For example, the osteogenesis scaffold can be configured so that ananisotropy of a physical property, such as stiffness, compressivestrength, elastic modulus, and the like, is the same or substantiallythe same as an anisotropy of the same physical property in the nativebone in the vicinity of the intended implantation. In an example, theporous scaffold can be configured to be stiffer in a first direction(e.g., axially) compared to a second direction (e.g., laterally), suchas to mimic anisotropic stiffness of nearby native bone in the firstdirection and second direction. The porous scaffold can be configured sothat the physical property, such as stiffness, is the same orsubstantially the same as the same physical property in the nearbynative bone in both the first direction and the second direction. In anexample, “substantially the same,” when referring to the matching of aphysical property between the porous scaffold and the nearby native bonecan refer to the value of the physical property of the porous scaffoldin the first direction being within about 10% or preferably within about5% of the value of the physical property of the nearby native bone inthe first direction, such as within 3%, 1%, or less. Similarly, thephysical property in the second direction can be considered to besubstantially the same if the value of the physical property of theporous scaffold in the second direction is within about 10% orpreferably within about 5%, or within 3%, 1%, or less of the value ofthe physical property of the nearby native bone in the second direction.

Referring to FIG. 1, there is illustrated a perspective view of anosteogenesis scaffold 10. The scaffold 10 can take any of a variety ofconfigurations depending upon the intended anatomical environment, andis illustrated in FIG. 1 in the form of a spinal fusion cage 12.

Fusion cage 12 comprises a superior support surface 14, and an inferiorsupport surface 16 spaced apart by a body portion 18. Measured in anaxial direction, the anterior side 20 typically has a greater heightthen a posterior side 22.

The osteogenesis cage 12 comprises a plurality of arcuate struts,configured to produce an implant having a functional modulus which is acomposite of the modulus of the material of construction, taken togetherwith the physical properties attributable to the architecture of theimplant. In the illustrated embodiment, the cage 12 comprises aplurality of arcuate struts configure to permit a degree of compressionand expansion in the axial (superior inferior) direction, in response tocyclic physiologic load. Each arcuate strut is configured to function asa leaf spring, within the constraints imposed by the material andgeometry of the struts.

In the illustrated embodiment, the superior support surface 14 comprisesa plurality of struts as will be discussed. Alternatively, the superiorsupport surface 14 and or inferior support service 16 may comprise aunitary apertured or porous plate or other construct for engaging theadjacent bony end plate.

In the illustrated embodiment, the superior support surface 14 comprisesa plurality of interior surface struts 24 extending radially outwardlyfrom a centerpoint 26 along the superior support surface 14. At leastabout two or four or six or eight or more interior surface struts 24 maybe provided. In the illustrated embodiment, four long struts intersectat the centerpoint 26 to provide eight interior surface struts 24.

The surface struts 24 described above may be reproduced on the inferiorsupport surface 16 in a symmetrical arrangement. The surface struts 24may reside in a plane. Preferably, however, the surface struts 24 definean arcuate surface which is slightly convex in a direction away from thebody 18, to complement the surface of the bony end plate of the adjacentvertebral body.

The superior support service 14 is spaced apart from the inferiorsupport surface 16 by, among other things, a plurality of peripheralaxial struts 28. In the illustrated embodiment, each of the radiallyoutwardly facing ends of the surface struts 24 is connected to an axialstrut 28. Thus, in the illustrated embodiment, eight axial struts 28 arepositioned about the periphery of the body 18. However, any of a varietyof numbers such as at least about four, six, eight, 10, 12 or more axialstruts 28 maybe provided depending upon the overall desired scaffolddesign. Axial struts 28 maybe linear, or, preferably, each axial strut28 may define an arc. In the illustrated embodiment, each of the axialstruts 28 is concave in the direction of the central axis of the body18. This may allow a slight axial compression of the body 18 underanatomical loads.

The intersections of the axial struts 28 and surface struts 24 areconnected by a superior peripheral frame 30. In the illustratedembodiment, the peripheral frame 30 comprises a continuous annularstrut, defining the outer periphery of the superior support surface 14.The inferior support surface 16 is provided with a symmetricalperipheral frame 32, defining the outer periphery of the inferiorsupport surface 16.

Referring to FIG. 2, there is illustrated a top plan view of thesuperior support surface 14. A plurality of diagonal surface struts 34join radial ends of alternating radial surface struts 24. Diagonalsurface struts 34 may be nonlinear, and, in the illustrated embodiment,are arcuate with a concavity pointing in the direction of the peripheryof the body 18. At least two or four or more diagonal surface struts 34may be provided in each plane such as the superior support surface 14.In the illustrated embodiment, four diagonal service struts 34 areprovided, intersecting the peripheral frame 30 at approximately 90°spacing.

The strut geometry residing in the plane of the superior support surface14 may be symmetrically reproduced for the inferior support surface 16.That strut geometry may be further reproduced within one or two or moreintermediate planes, residing in between the superior support surface 14and inferior support surface 16.

Referring to FIG. 3, there is illustrated a vertical cross-sectionthrough a central surface strut 24. Within the body 18, a plurality ofstruts are provided. At least about 50%, preferably least about 80%, andtypically at least about 90 or 95% of the struts are curved.

The first concave upward strut 40 extends from the peripheral frame 30on the superior support surface 14, to the inferior support surface 16,and back to a second end of the peripheral frame 30 on superior supportsurface 14. A second concave upward strut 42 extends from the inferiorframe 32 to the centerpoint 26 on the superior support surface 14. Eachof the first second and third concave upward struts have an arcuateconfiguration with an upward facing concavity.

Referring to FIGS. 4 and 5, the peripheral surface of the body 18 isprovided with a dock 60, for releasable engagement with an insertiontool. The dock 60 may be provided with an aperture, projection, or othersurface structure (not illustrated) which is complementary to a distalportion of an insertion tool. For example, the dock 60 may be providedwith a threaded aperture for threadable engagement with a threadeddistal end of an insertion tool. The dock 60 is preferably provided on aperipheral surface of the implant, and maybe on the posterior, anterior,lateral or posterior lateral sides, depending upon the desired route ofimplantation.

In general, the implant 10 is formed as a cage having a unitary body,with openings provided through the top and bottom surfaces to formcavities or passageways throughout, wherein openings from the topsurface are in communication with openings from the bottom surface andare configured and dimensioned to receive graft material, such as boneparticles or chips, demineralized bone matrix (DBM), paste, bonemorphogenetic protein (BMP) substrates or any other bond graftexpanders, or other substances designed to encourage bone ingrowth intothe cavities to facilitate the fusion. Additionally the implant 10 maybe provided with side openings as shown that are also in communicationwith the interior cavities.

The implant 10 may be made from any of a variety of materials well knownin the orthopedic implant arts. For example, implants may be made fromPEEK (polyetheretherketone) such as by being machined therefrom, butalternatively, may be manufactured by injection molding orthree-dimensional lithographic printing, for example. When manufacturedby three-dimensional lithographic printing, implant 10 may be made ofpolymers, such as PEEK or other polymer and/or absorbable materials suchas tri-calcium phosphate (TCP), hydroxyapatite (HA) or the like. Whenmade of metal, implant 10 may be machined or made by metal powderdeposition, for example. Alternatively, implant 10 may be made of PEKK(poly(oxy-p-phenyleneisophthaloyl-phenylene/oxy-p-phenylenetere-phthaloyl-p-phenylene)or carbon-filled PEEK. Manufacturing the implant from any of thesematerials make it radiolucent, so that radiographic visualization can beused to view through the implant 10 to track the post-procedural resultsand progress of the fusion over time. Alternatively, implant 10 could bemade of titanium or other biocompatible, radiopaque metal. However, thisis less preferred as this type of implant would obscure post-proceduralradiographic monitoring.

Preferably, the implant comprises a metal such as titanium or a titaniumalloy, manufactured using a 3D printing technology. Such technologiesare known in several variations, sometimes referred to as Additivemanufacturing, rapid prototyping, solid free form technology, powder bedfusion, in which a bed of powdered metal is selectively fused (throughsintering or melting) by a laser or electric arc. Also, electron beammelting of metal powder (EBM) may be used.

The three-dimensional lattice configuration of the present invention,including configurations constructed from a plurality of arcuate strutsmay be adapted for use in a variety of orthopedic applications outsideof the spine. For example, intramedullary nails for use in long bonessuch as the femur, tibia, fibula, radius or ulna may be constructedusing the arcuate struts of the present invention, to provide ananisotropic characteristic such as modulus, to match that of the nativesurrounding environment. Extra medullary implants, such as plates,screws, spacers, rods, sacroiliac joint fusion implants or others mayalso be constructed utilizing the 3D printed arcuate strut or latticeconfigurations disclosed here in.

The implants disclosed herein may be provided with a porous or texturedsurface, such as to facilitate osteogenesis or in the case of poroussurfaces, to elute drugs such as antibiotics, anticoagulants, bonegrowth factors or others known in the art.

Implants produce in accordance with the present invention mayalternatively comprise hybrid constructs, with a first component madefrom 3-D printed lattice and a second component molded, machined orotherwise formed from a conventional implant material such as titanium,various metal alloys, PEEK, PEBAX or others well known in the art.

What is claimed is:
 1. An osteogenesis scaffold configured for spinalfusion, comprising: a superior support surface; an inferior supportsurface; a plurality of arcuate struts separating the superior andinferior support surfaces, the struts comprising a material having astrut modulus; the scaffold having a functional modulus which isdifferent than the strut modulus and is the result of the strut modulusand the architecture of the implant.